Posts Tagged ‘FRAX’

Not Just DXA – Fracture Risk !!

February 22, 2015 @ 9:39 pm
posted by Dr Ginther

DXA is very good at determining Bone Mineral Density (BMD), provided you look at the images and over-read the computer.  DXA alone is less good at predicting Fracture Risk.  But, Fractures are what we want to avoid.

At the International Society for Clinical Densitometry (ISCD) meeting this week, we will discuss the other modalities, which supplement DXA to obtain greater accuracy.  Vertebral Fracture Assessment (VFA) helps evaluate bone quality.  FRAX was specifically designed to predict Fracture Risk.  QCT (Quantitative Computerized Tomography) has been added in recent years as an alternative to DXA.

ISCD will discuss adding  TBS (Trabecular Bone Score), Hip Structural Analysis, Hip Axis Length, and uses of Central CT.  We are constantly pushing toward our goal – Prevent Fractures.

Preventing Fractures is not just DXA.  Get a Complete Bone Health Evaluation.

Take Control of your future.  Check your bone health.

Jay Ginther, MD

How Hard Is It To Manage Bone Density?

November 23, 2014 @ 7:57 pm
posted by Dr Ginther

Wrong Question!  What you should be managing is Fracture Risk.  If you only look at Bone Mineral Density (BMD), you miss the chance to decrease Fracture Risk in the overwhelming majority of people.

85% of the women who Fracture have a DXA score of “osteopenia” or even “normal”.  Keeping their bone density at “only osteopenia” does them no favor.  So how can you manage Fracture Risk?

Forteo is a daily shot.  That is a nuicence, but a small price to pay for the only Anabolic, the only osteoporosis medication which will increase bone mass in spongy (cancellous) bone.  Diabetics give themselves a daily shot for the rest of their lives.  Forteo is for only 2 years and uses a tiny insulin needle. 

People worry about the warning that lab rats got Osteosarcoma after being given very high doses of Teriparatide for the equivalent of 70 human years.  We have not seen this in humans, or chimps, or monkeys, or dogs.  Rats have bones that grow all their lives.  We do not give Forteo to growing humans, pregnant women, nursing women, persons with Paget’s Disease or unexplained elevated Alkaline Phosphatase, or persons who have had radiation to their bones.

Remember that you must take adequate Calcium, with food, spread out over 3 meals. You must take enough Vitamin D3 to be able to absorb Calcium.  You must eat enough Protein for your OsteoBlasts to make new bone matrix.

The American Society of Clinical Oncology received bad news about Breast Cancer Patients this week.  A study of women with breast cancer, being treated with Aromatase Inhibitors (AI), was presented at the 2014 Breast Cancer Symposium.  AI is a great treatment for breast cancer, however…

AI is known to decrease bone strength and to increase Fracture Risk.  How many of these patients  were evaluated for their bone health?  Only 54%.  How many got a repeat evaluation to check to be sure that their bone health was not deteriorating?  Only 46%.

Of those tested, 43% had a DXA T-score in the “osteopenia” range.  In this situation, FRAX is needed to calculate Fracture Risk.  41% of this group met guidelines for treatment with medication to prevent bone loss and Fractures.  Of those who should have been treated, only 23% were.